BILL NUMBER: AB 776	CHAPTERED  06/30/00

	CHAPTER   54
	FILED WITH SECRETARY OF STATE   JUNE 30, 2000
	APPROVED BY GOVERNOR   JUNE 30, 2000
	PASSED THE ASSEMBLY   JUNE 15, 2000
	PASSED THE SENATE   JUNE 8, 2000
	AMENDED IN SENATE   APRIL 27, 2000
	AMENDED IN ASSEMBLY   JANUARY 13, 2000
	AMENDED IN ASSEMBLY   MAY 6, 1999
	AMENDED IN ASSEMBLY   APRIL 26, 1999

INTRODUCED BY   Assembly Member Calderon

                        FEBRUARY 24, 1999

   An act to amend Section 139.2 of the Labor Code, relating to
workers' compensation.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 776, Calderon.  Workers' compensation:  medical evaluators:
reappointment.
   Existing law, for purposes of workers' compensation, requires the
Industrial Medical Council to appoint qualified medical evaluators
for the evaluation of medical issues, and these appointments are for
a 2-year term.  Existing law permits a medical evaluator to request
reappointment if he or she meets specified qualifications that
include having completed within the previous 24 months 12 hours of
continuing education, as specified.
   This bill would require the appointment of qualified medical
evaluators for the evaluation of medical-legal issues.  The bill
would clarify who is a physician for purposes of appointment or
reappointment as a qualified medical evaluator.  The bill would
revise the qualifications for the appointment and reappointment of
medical evaluators, including, among other changes, a requirement
that appointees complete a course approved by the Industrial Medical
Council of 12 or more hours on disability evaluation report writing.
This bill would also revise the grounds for suspension or
termination by the council of the privilege of a physician to serve
as a qualified medical evaluator.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  Section 139.2 of the Labor Code is amended to read:
   139.2.  (a) The Industrial Medical Council shall appoint qualified
medical evaluators in each of the respective specialties as required
for the evaluation of medical-legal issues.  The appointments shall
be for two-year terms.
   (b) The council shall appoint or reappoint as a qualified medical
evaluator a physician, as defined in Section 3209.3, who is licensed
to practice in this state and who demonstrates that he or she meets
the requirements in paragraphs (1), (2), (6), and (7), and, if the
physician is a medical doctor, doctor of osteopathy, doctor of
chiropractic, or a psychologist, that he or she also meets the
applicable requirements in paragraph (3), (4), or (5).
   (1) Prior to his or her appointment as a qualified medical
evaluator, passes an examination written and administered by the
Industrial Medical Council for the purpose of demonstrating
competence in evaluating medical-legal issues in the workers'
compensation system.  Physicians shall not be required to pass an
additional examination as a condition of reappointment.  A physician
seeking appointment as a qualified medical evaluator on or after
January 1, 2001, shall also complete prior to appointment, a course
on disability evaluation report writing approved by the Industrial
Medical Council.  The Industrial Medical Council shall specify the
curriculum to be covered by disability evaluation report writing
courses, which shall include, but is not limited to, 12 or more hours
of instruction.
   (2) Devotes at least one-third of total practice time to providing
direct medical treatment, or has served as an agreed medical
evaluator on eight or more occasions in the 12 months prior to
applying to be appointed as a qualified medical evaluator.
   (3) Is a medical doctor or doctor of osteopathy and meets one of
the following requirements:
   (A) Is board certified in a specialty by a board recognized by the
council and either the Medical Board of California or the
Osteopathic Medical Board of California.
   (B) Has successfully completed a residency training program
accredited by the American College of Graduate Medical Education or
the osteopathic equivalent.
   (C) Was an active qualified medical evaluator on June 30, 2000.
   (D) Has qualifications that the council and either the Medical
Board of California or the Osteopathic Medical Board of California,
as appropriate, both deem to be equivalent to board certification in
a specialty.
   (4) Is a doctor of chiropractic and meets either of the following
requirements:
   (A) Has completed a chiropractic postgraduate specialty program of
a minimum of 300 hours taught by a school or college recognized by
the council, the Board of Chiropractic Examiners and the Council on
Chiropractic Education.
   (B) Has been certified in California workers' compensation
evaluation by a provider recognized by the council.  The
certification program shall include instruction on disability
evaluation report writing that meets the standards set forth in
paragraph (1).
   (5) Is a psychologist and meets one of the following requirements:

   (A) Is board certified in clinical psychology by a board
recognized by the council.
   (B) Holds a doctoral degree in psychology, or a doctoral degree
deemed equivalent for licensure by the Board of Psychology pursuant
to Section 2914 of the Business and Professions Code, from a
university or professional school recognized by the council and has
not less than five years' postdoctoral experience in the diagnosis
and treatment of emotional and mental disorders.
   (C) Has not less than five years' postdoctoral experience in the
diagnosis and treatment of emotional and mental disorders, and has
served as an agreed medical evaluator on eight or more occasions
prior to January 1, 1990.
   (6) Does not have a conflict of interest as determined under the
regulations promulgated by the administrative director pursuant to
subdivision (o).
   (7) Meets any additional medical or professional standards adopted
pursuant to paragraph (6) of subdivision (j).
   (c) The council shall promulgate standards for appointment of
physicians who are retired or who hold teaching positions who are
exceptionally well qualified to serve as a qualified medical
evaluator even though they do not otherwise qualify under paragraph
(2) of subdivision (b).  In no event shall a physician whose
full-time practice is limited to the forensic evaluation of
disability be appointed as a qualified medical evaluator under this
subdivision.
   (d) The qualified medical evaluator, upon request, shall be
reappointed if he or she meets the qualifications of subdivision (b)
and meets all of the following criteria:
   (1) Is in compliance with all applicable regulations and
evaluation guidelines adopted by the council.
   (2) Has not had more than five of his or her evaluations which
were considered by a workers' compensation judge at a contested
hearing rejected by the judge or the appeals board pursuant to this
section during the most recent two-year period during which the
physician served as a qualified medical evaluator.  If the judge or
the appeals board rejects the qualified medical evaluator's report on
the basis that it fails to meet the minimum standards for those
reports established by the Industrial Medical Council or the appeals
board, the judge or the appeals board, as the case may be, shall make
a specific finding to that effect, and shall give notice to the
medical evaluator and to the Industrial Medical Council.  Any
rejection shall not be counted as one of the five qualifying
rejections until the specific finding has become final and time for
appeal has expired.
   (3) Has completed within the previous 24 months at least 12 hours
of continuing education in impairment evaluation or workers'
compensation-related medical dispute evaluation approved by the
Industrial Medical Council.
   (4) Has not been terminated, suspended, placed on probation, or
otherwise disciplined by the council during his or her most recent
term as a qualified medical evaluator.
   If the evaluator does not meet any one of these criteria, the
Industrial Medical Council may in its discretion reappoint or deny
reappointment according to regulations promulgated by the council.
In no event may a physician who does not currently meet the
requirements for initial appointment or who has been terminated under
subdivision (e) because his or her license has been revoked or
terminated by the licensing authority be reappointed.
   (e) The council may, in its discretion, suspend or terminate a
qualified medical evaluator during his or her term of appointment
without a hearing as provided under subdivision (k) or (l) whenever:
(1) the evaluator's license to practice in California has been
suspended by the relevant licensing authority so as to preclude
practice, or has been revoked or terminated by the licensing
authority; or, (2) the evaluator has failed to timely pay the fee
required by the council pursuant to subdivision (n).
   (f) The Industrial Medical Council shall furnish a physician, upon
request, a written statement of its reasons for termination of or
for denying appointment or reappointment as a qualified medical
evaluator.  Upon receipt of a specific response to the statement of
reasons, the Industrial Medical Council shall review its decision not
to appoint or reappoint the physician or to terminate the physician
and shall notify the physician of its final decision within 60 days
after receipt of the physician's response.
   (g) The council shall establish agreements with qualified medical
evaluators to assure the expeditious evaluation of cases assigned to
them for comprehensive medical evaluations.
   (h) When the injured worker is not represented by an attorney, the
medical director appointed pursuant to Section 122, shall assign
three-member panels of qualified medical evaluators within five
working days after receiving a request for a panel.  If a panel is
not assigned within 15 working days, the employee shall have the
right to obtain a medical evaluation from any qualified medical
evaluator of his or her choice.  The medical director shall use a
random selection method for assigning panels of qualified medical
evaluators.  The medical director shall select evaluators who are
specialists of the type selected by the employee.  The medical
director shall advise the employee that he or she should consult with
his or her treating physician prior to deciding which type of
specialist to request.  The Industrial Medical Council shall
promulgate a form which shall notify the employee of the physicians
selected for his or her panel.  The form shall include, for each
physician on the panel, the physician's name, address, telephone
number, specialty, number of years in practice, and a brief
description of his or her education and training, and shall advise
the employee that he or she is entitled to receive transportation
expenses and temporary disability for each day necessary for the
examination.  The form shall also state in a clear and conspicuous
location and type:  "You have the right to consult with an
information and assistance officer at no cost to you prior to
selecting the doctor to prepare your evaluation, or you may consult
with an attorney.  If your claim eventually goes to court, the judge
will consider the evaluation prepared by the doctor you select to
decide your claim."  When compiling the list of evaluators from which
to select randomly, the medical director shall include all qualified
medical evaluators who:  (1) do not have a conflict of interest in
the case, as defined by regulations adopted pursuant to subdivision
(o); (2) are certified by the council to evaluate in an appropriate
specialty and at locations within the general geographic area of the
employee's residence; and, (3) have not been suspended or terminated
as a qualified medical evaluator for failure to pay the fee required
by the council pursuant to subdivision (n) or for any other reason.
When the medical director determines that an employee has requested
an evaluation by a type of specialist which is appropriate for the
employee's injury, but there are not enough qualified medical
evaluators of that type within the general geographic area of the
employee's residence to establish a three-member panel, the medical
director shall include sufficient qualified medical evaluators from
other geographic areas and the employer shall pay all necessary
travel costs incurred in the event the employee selects an evaluator
from another geographic area.
   (i) The medical director appointed pursuant to Section 122, shall
continuously review the quality of comprehensive medical evaluations
and reports prepared by agreed and qualified medical evaluators and
the timeliness with which evaluation reports are prepared and
submitted.  The review shall include, but not be limited to, a review
of a random sample of reports submitted to the division, and a
review of all reports alleged to be inaccurate or incomplete by a
party to a case for which the evaluation was prepared.  The medical
director shall submit to the administrative director an annual report
summarizing the results of the continuous review of medical
evaluations and reports prepared by agreed and qualified medical
evaluators and make recommendations for the improvement of the system
of medical evaluations and determinations.
   (j) After public hearing pursuant to Section 5307.4, the council
shall promulgate rules and regulations concerning the following
medical issues:
   (1) Standards governing the timeframes within which medical
evaluations shall be prepared and submitted by agreed and qualified
medical evaluators.  Except as provided in this subdivision, the
timeframe for initial medical evaluations to be prepared and
submitted shall be no more than 30 days after the evaluator has seen
the employee or otherwise commenced the medical evaluation procedure.
  The council shall develop regulations governing the provision of
extensions of the 30-day period in cases:  (A) where the evaluator
has not received test results or consulting physician's evaluations
in time to meet the 30-day deadline; and, (B) to extend the 30-day
period by not more than 15 days when the failure to meet the 30-day
deadline was for good cause.  For purposes of this subdivision, "good
cause" means:  (i) medical emergencies of the evaluator or evaluator'
s family; (ii) death in the evaluator's family; or, (iii) natural
disasters or other community catastrophes that interrupt the
operation of the evaluator's business.  The council shall develop
timeframes governing availability of qualified medical evaluators for
unrepresented employees under Sections 4061 and 4062.  These
timeframes shall give the employee the right to the addition of a new
evaluator to his or her panel, selected at random, for each
evaluator not available to see the employee within a specified period
of time, but shall also permit the employee to waive this right for
a specified period of time thereafter.
   (2) Procedures to be followed by all physicians in evaluating the
existence and extent of permanent impairment and limitations
resulting from an injury.  In order to produce complete, accurate,
uniform, and replicable evaluations, the procedures shall require
that an evaluation of anatomical loss, functional loss, and the
presence of physical complaints be supported, to the extent feasible,
by medical findings based on standardized examinations and testing
techniques generally accepted by the medical community.
   (3) Procedures governing the determination of any disputed medical
issues.
   (4) Procedures to be used in determining the compensability of
psychiatric injury.  The procedures shall be in accordance with
Section 3208.3 and shall require that the diagnosis of a mental
disorder be expressed using the terminology and criteria of the
American Psychiatric Association's Diagnostic and Statistical Manual
of Mental Disorders, Third Edition-Revised, or the terminology and
diagnostic criteria of other psychiatric diagnostic manuals generally
approved and accepted nationally by practitioners in the field of
psychiatric medicine.
   (5) Guidelines for the range of time normally required to perform
the following:
   (A) A medical-legal evaluation that has not been defined and
valued pursuant to Section 5307.6.  However, the council may
recommend guidelines for evaluations that have been defined and
valued pursuant to Section 5307.6 for the purpose of governing the
appointment, reappointment, and discipline of qualified medical
evaluators.  The guidelines shall establish minimum times for patient
contact in the conduct of the evaluations, and shall be consistent
with regulations adopted pursuant to Section 5307.6.
   (B) Any treatment procedures that have not been defined and valued
pursuant to Section 5307.1.
   (C) Any other evaluation procedure requested by the administrative
director, the Insurance Commissioner, or the council itself.
   If, without good cause, the council fails to adopt the guidelines
required by subparagraph (A) or (B) by March 31, 1994, or fails,
without good cause, to adopt a guideline pursuant to subparagraph (C)
within six months after a request by the administrative director or
the Insurance Commissioner, then the administrative director shall
have the authority to adopt the guideline.
   (6) Any additional medical or professional standards which a
medical evaluator shall meet as a condition of appointment,
reappointment, or maintenance in the status of a medical evaluator.
   (k) Except as provided in this subdivision, the Industrial Medical
Council may, in its discretion, suspend or terminate the privilege
of a physician to serve as a qualified medical evaluator if the
council, after hearing pursuant to subdivision (l), determines, based
on substantial evidence, that a qualified medical evaluator:
   (1) Has violated any material statutory or administrative duty.
   (2) Has failed to follow the medical procedures or qualifications
established by the council pursuant to paragraph (2), (3), (4), or
(5) of subdivision (j).
   (3) Has failed to comply with the timeframe standards established
by the council pursuant to subdivision (j).
   (4) Has failed to meet the requirements of subdivision (b) or (c).

   (5) Has prepared medical-legal evaluations that fail to meet the
minimum standards for those reports established by the Industrial
Medical Council or the appeals board.
   (6) Has made material misrepresentations or false statements in an
application for appointment or reappointment as a qualified medical
evaluator.
   No hearing shall be required prior to the suspension or
termination of a physician's privilege to serve as a qualified
medical evaluator when the physician has:  (A) failed to timely pay
the fee required by the council pursuant to subdivision (n); or, (B)
had his or her license to practice in California suspended by the
relevant licensing authority so as to preclude practice, or had the
license revoked or terminated by the licensing authority.
   (l) The council shall cite the qualified medical evaluator for a
violation listed in subdivision (k) and shall set a hearing on the
alleged violation within 30 days of service of the citation on the
qualified medical evaluator.  In addition to the authority to
terminate or suspend the qualified medical evaluator upon finding a
violation listed in subdivision (k), the council may, in its
discretion, place a qualified medical evaluator on probation subject
to appropriate conditions, including ordering continuing education or
training.  The council shall report to the appropriate licensing
board the name of any qualified medical evaluator who is disciplined
pursuant to this subdivision.
   (m) The council shall terminate from the list of medical
evaluators any physician where licensure has been terminated by the
relevant licensing board, or who has been convicted of a misdemeanor
or felony related to the conduct of his or her medical practice, or
of a crime of moral turpitude.  The council shall suspend or
terminate as a medical evaluator any physician who has been suspended
or placed on probation by the relevant licensing board.  If a
physician is suspended or terminated as a qualified medical evaluator
under this subdivision, a report prepared by the physician that is
not complete, signed, and furnished to one or more of the parties
prior to the date of conviction or action of the licensing board,
whichever is earlier, shall not be admissible in any proceeding
before the appeals board nor shall there be any liability for payment
for the report and any expense incurred by the physician in
connection with the report.
   (n) Each qualified medical evaluator shall pay a fee, as
determined by the Industrial Medical Council, for appointment or
reappointment.  Any qualified medical evaluator appointed prior to
January 1, 1993, shall also pay the same fee as specified herein.
These fees shall be based on a sliding scale as established by the
council.  All revenues from fees paid under this subdivision shall be
deposited into the Industrial Medicine Fund, which is hereby created
for the administration of the Industrial Medical Council.  Moneys
paid into the Industrial Medicine Fund for the activities of the
Industrial Medical Council shall not be used by any other department
or agency or for any purpose other than administration of the
council.  The funds provided to the council from the Industrial
Medicine Fund shall not supplant any funds appropriated to the
council from the Workers' Compensation Administration Revolving Fund,
the General Fund, or any other governmental source.  Any future
annual appropriation to the council from the Workers' Compensation
Administration Revolving Fund, the General Fund, or any other
governmental source shall not be less than the amount appropriated or
provided during the 1991-92 fiscal year.
   (o) An evaluator may not request or accept any compensation or
other thing of value from any source that does or could create a
conflict with his or her duties as an evaluator under this code.  The
administrative director, after consultation with the council and the
Commission on Health and Safety and Workers' Compensation, shall
adopt regulations to implement this subdivision on or before July 1,
1994.
